Page 9 - Lake Avenue Church Benefits Guide 2018 5.22

Vision Benefits

Vision Insurance

Anthem Blue Cross| Blue Vision Plan
The Anthem Blue Cross vision plan provides professional vision care and high-quality lenses and frames through a broad network of
optical specialists. You will receive richer benefits if you utilize a network provider. If you use a non‐network provider, you will be
responsible for paying all charges at the time of your appointment and will be required to file an itemized claim with Anthem Blue
Cross.

Anthem Blue Cross
Plan Name Blue View Vision Network

Network Name In-Network Non-Network
Vision Benefits Reimbursement

Copay
- Examination $20 Copay N/A
- Materials $0 Copay N/A
Examination (Every 12 Months) 100% Up to $49
Lenses (Every 12 Months)
- Single Vision 100% Up to $35
- Bifocal 100% Up to $49
- Trifocal 100% Up to $74
Frames (Every 24 Months) Up to $130, 20% off Up to $50
Contact Lenses (Every 12 Months) In Lieu of Frames and Lenses

- Cosmetic Up to $130 Up to $92
- Elective 100% Up to $250
Laser Vision Correction Discounts Apply Not Covered

Finding In-Network Vision Providers
Go to www.anthem.com/ca or call (866) 723-0515.
Refer to the Blue View Vison Network when prompted.

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